Turkmenistan: Ashgabat in HIV Denial

HIV-awareness pamphlets are available in a Turkmen village clinic. (Photo: EurasiaNet)

Turkmenistan is courting a public health calamity because officials are systematically denying an HIV infection problem, experts say.

Foreign and local HIV experts and medical workers assert authorities are deliberately manipulating infection statistics, as well as preventing the registration of new cases. As a result, some doctors fear an imminent epidemic.

Ashgabat has officially acknowledged only two cases of HIV infection since it gained independence in 1991. Both HIV patients have died and officials say there have been no new cases, leaving the official number of HIV-infected individuals in Turkmenistan at zero. Health workers on the ground, however, scoff at the official claim.

“In every region, doctors register cases,” a healthcare professional in Ashgabat told EurasiaNet.org. “In some cases, they don’t even inform a person who is found positive.” One doctor in the Caspian port town of Turkmenbashi said he had registered eight infections. His superior told the Ministry of Health that the town had zero cases.

“It is well known among health workers that HIV spreads here with drugs. Almost all infections are among drug users,” said the healthcare professional. (Because of the sensitivity of the subject, all sources for this article requested anonymity. Locals fear harassment of their families; foreigners worry about restricted access to the country).

Officially, the country has 30,000 injecting drug users, but experts believe the number is several times higher. Most use heroin that comes from across the border with Afghanistan. Throughout Central Asia, HIV infections are increasing, especially along routes used to traffic Afghan heroin to Russia.

A study by the Central Asia AIDS Control Project estimates that, across the region, 67 percent of HIV-infections occur through shared needles. According to UNICEF, roughly only half the young people in the region have had exposure to HIV-prevention information.

Despite the evident risks, “officials are taking no real actions to prevent HIV among drug users,” said an international official familiar with Ashgabat’s drug control policy. “It’s political paralysis. No one wants to take any responsibility for taking a bold decision because then you have to reform the whole system.”

Ashgabat residents note a significant change in their city since President Gurbanguly Berdymukhamedov came to power four years ago: Police have begun arresting drug users in greater numbers.

“Before, under the previous president, everyone knew where to buy and how much it cost. Every family I know had someone using drugs,” said the healthcare professional in Ashgabat. “But the problem now is that there is no flexibility. Authorities arrest a young man who uses, put him in jail with everyone else, and he becomes a criminal.”

Or he becomes even more likely to contract HIV. A 2006 UN survey said 27 percent of all prisoners in Turkmenistan inject drugs.

Officials’ insistence that Turkmenistan is HIV-free is ridiculed and lamented by experts inside and outside the country. Because the number is zero, health officials decline to import anti-retroviral drugs to treat those infected with HIV.

The infected number is “close to 1,000” believes the international official. “It’s difficult to explain why officials don’t open up these figures. Perhaps they are embarrassed to go from zero to many hundreds of new cases of HIV. Then it looks like an outbreak,” the expert said. “But it is very frustrating because practically everyone knows there are hundreds of HIV-positive drug users.”

In 2009, the Paris-based Doctors Without Borders (MSF) decided to withdraw from Turkmenistan after 10 years of working there because the government “is masking a dangerous public health situation as the existence of infectious disease is denied, medical data is systemically manipulated and international standards and protocols are rarely applied in practice.”

Turkmen officials need to admit a problem rather than “downplaying” the danger, said a Russian HIV expert with over a decade of experience studying the disease in Central Asia, including Turkmenistan. Though mid-level officials do understand the danger, fear of the top-level authorities, “right up to Berdymukhamedov,” keeps doctors quiet. International officials must address HIV at the highest levels of Turkmenistan’s government, he said. But they don’t because they are too afraid they will lose access to the country.

Ashgabat is more concerned with its international image than improving public health, MSF said in an April 2010 statement. The organization also lashed out at international donors for “giving a veneer of legitimacy to misinformation from the government and to practices that are not only ineffective, but often dangerous.”

Earlier in February, in a report blasting the donor community for “complicity” in Turkmenistan’s campaign to falsify numbers, the International Crisis Group said that “when widely respected international organizations abet governments in hiding and distorting reality, they not only fail to justify working in these states, but they also bear equal responsibility for the present situation and future failures.”

“People who come here must know where to push. They don’t and our government takes advantage of this,” said the healthcare professional in Ashgabat.

One argument international donors could address: that HIV affects only drug users and sex workers. “Officials don’t think that those with moral faults deserve help. But when HIV penetrates drug use networks, it never stays there,” said the Russian HIV expert. “Sooner or later it will penetrate the population. Even drug users have sex and through sex the virus moves into the wider population. It’s happening all over Central Asia.”

In Ashgabat, the healthcare professional cautioned the spread might already be taking another, less visible path. “We have a lot of new cases of hepatitis C being diagnosed -- most of it is spread by dentists and other healthcare providers. That suggests there is already a dangerous spread of HIV, which spreads the same way. Dentists reuse their equipment.”